Trans people frequently face discrimination whilst looking for work, which further limits their employment choices that are often already reduced due to educational discrimination. This makes them more likely to work jobs that come with low pay and poor working conditions: long/antisocial hours, lack of flexibility, low job security, labour that is physically demanding and/or risky, increased exposure to pollution and weather due to work environment, etc. Forty percent of trans people are low income, and 12.5% are unable to work entirely (source).

With housing choices typically already seriously limited by low income, trans people also commonly experience discrimination when looking for housing, both from landlords and potential housemates. This combines to mean that trans people disproportionately live in poor quality housing that comes with risks like mould exposure, poor ventilation, and lowered protection from cold, heat and weather events; as well as typically being in areas subjected to higher levels of pollution. Additionally, 25% of trans people have experienced homelessness during their lives (source), once again leading to elevated exposure to pollution, weather, and violence; this often results in long periods of time spent without anywhere to rest or feel safe, thus existing in a perpetually high-stress state.

Trans people experience discrimination and harassment at alarmingly high levels. Forty-one percent of trans people have experienced a hate crime or incident in the past year. Twenty-eight percent of trans people in a relationship have faced domestic abuse from a partner in the past year. Twelve percent of trans employees have been physically attacked by colleagues or customers in the last year (source). Nearly half of all trans people in the US report being sexually assaulted at least once during their lifetime (source). Even these staggeringly high percentages fail to accurately represent the reality many trans people face; harassment and discrimination often become a near-constant background noise that comes from everywhere: family, friends, partners, colleagues, strangers, social media, a never-ending media circus “debating” trans people… These various traumas can take a serious toll on both the physical and mental health of trans people.

Many transmasculine people bind their chests to give the appearance of a flat(ter) chest. This is usually done with purpose-made binders, but some trans people who cannot access them (especially trans youth with unsupportive parents) turn to alternative methods, such as using ace bandages, which can result in serious damage to the ribs and negatively impact breathing. Using purpose-made binders and following “safe binding” guidelines (such as only wearing a binder for 8 hours per day) significantly reduces risks, but 89% of those who bind regularly report at least one negative side effect, such as skin irritation, acne and back pain (source). Similarly, some transfeminine people utilise a technique known as tucking: the testicles are gently pushed up into the inguinal canal, the scrotum and penis are then pulled backward and secured between the buttocks. Research on this practice is sparse, but commonly reported side effects are skin irritation and testicular pain, with testicular torsion sometimes seen in those with a long history of tucking (source).

Trans people (especially transfeminine people) using gendered toilets has been the subject of intense public discourse in recent years. Alongside this, trans people have experienced increased rates of harassment in public toilets. This can have significant impacts, with the 2015 US Transgender Survey showing:

• 59% have avoided bathrooms in the last year because they feared confrontations in public restrooms at work, at school, or in other places.

• 31% have avoided drinking or eating so that they did not need to use the restroom in the last year.

• 8% report having a kidney or urinary tract infection, or another kidney-related medical issue, from avoiding restrooms in the last year.

Unsurprisingly, kinds of healthcare that are widely considered “gendered” can be very difficult for trans people to engage with. Gynaecology is a prime example, with transmasculine individuals describing feeling alienated by healthcare leaflets that proceed with the assumption that all gynaecology patients will be women, feeling very observed in waiting rooms, and even being told by receptionists that they must be in the wrong place. This has very real health impacts: trans men are 37% less likely to be current with their Pap test than cisgender patients (source). A UK survey highlighted how only 58% of trans men eligible for cervical screening have ever been screened; and even amongst those who had been screened, 65% reported having delayed testing at least once. This poor screening uptake is likely to be – at least in part – responsible for the elevated rates of cervical cancer seen in trans men (source).

There is also a history of blaming cervical cancer on testosterone HRT, which created a medical practice of strongly encouraging, or even enforcing, the removal of uteruses after five years of HRT. While rules enforcing this are being relaxed in some cases due to poor evidence – and a growing recognition that the elevated rates are likely related to cervical cancer screening disparities – many professionals responsible for delivering trans healthcare still believe this to be true, and strongly encourage the removal of healthy uteruses, even if they are not causing the patient any distress. This exemplifies the cultural desire to control trans bodies and limit the possibilities of what they can be and look like, and can also be seen as a roundabout way of sterilising trans people. In a number of countries, it is even required for trans people to be surgically sterilised in order to obtain legal gender recognition (source). 

Many trans people report experiencing repeated and/or intentional misgendering from medical professionals, as well as transphobic remarks and language (source). The experience of seeking transition-related medical care (such as hormones and/or surgery) is often negative, with trans people commonly reporting being asked invasively personal (and irrelevant) questions, extensive bureaucracy, and ultimately feeling that medical professionals are working against them, rather than with them. These experiences often leave trans people very unwilling to interact with the medical system, meaning they are more likely to wait until symptoms become debilitating rather than getting checked out early.

When trans people do seek out medical care, they often receive worse quality care than their cisgender counterparts. Research around trans health is severely limited, with more attention paid to “satisfaction rates” than to how exogenous hormones might interact with various health conditions and risk factors. This lack of knowledge combines dangerously with transphobia, often playing out in a phenomenon that has been dubbed “trans broken arm syndrome” – where doctors are quick to assume all medical issues are related to being trans and/or to hormone replacement therapy (HRT).

“Transition-related healthcare is notorious for long-waiting lists, unnecessarily strict requirements and a lack of local services. But general healthcare is fraught with difficulties too. Trans people are frequently subject to poor standards of care due to prejudice or plain ignorance. Then there’s the phenomenon known as Trans Broken Arm Syndrome. It’s when healthcare providers assume that all medical issues are a result of a person being trans. Everything – from mental health problems to, yes, broken arms.” (source).